Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Tuesday, November 24, 2009

It isn't influenza, so who cares?

Extending the Cure, a project of Resources for the Future, works to make sure we still have antibiotics that work. Yes, they are somewhat redundant and repetitive with my friends at Alliance for the Prudent Use of Antibiotics, but their writ is a bit broader than APUA's since they also focus on policies to make developing new antibiotics more attractive to drug companies. Antibiotics are not big profit centers because they are given in short courses of a week or ten days, so the drug companies would rather focus on pills you have to take for a long time, preferably the rest of your life. Of course, without antibiotics, a lot of us wouldn't have any rest of our lives. But I digress.

MRSA is, of course, methicillin resistant Staphylococcus aureus, a common pathogen that has acquired resistance to a major class of antibiotics called beta lactams, which includes penicillin-like drugs. For a long time, it has been a major cause of nosocomial (hospital-acquired) infections, but more and more it is found in people coming to the hospital, who picked it up out here in the real world. Not only is it antibiotic resistant, it seems to be more virulent than non-resistant strains and can lead to severe necrotizing infections (that destroy tissue) or septicemia and death. Ugh.

To quote the press release from Resources for the Future:

Over the length of the study, researchers found that the proportion of MRSA increased more than 90 percent among outpatients with staph and now accounts for more than 50 percent of all Staphylococcus aureus infections. The findings suggest that this was due almost entirely to an increase in community-associated strains, which jumped from 3.6 percent of all MRSA infections to 28.2 percent—a seven-fold jump from 1999 to 2006. Similar increases in inpatients suggest that these strains are spreading rapidly into hospitals as well.

MRSA kills an estimated 20,000 people in the United States each year. The superbug, which is resistant to most common antibiotics, can attack wounds and trigger potentially lethal blood stream infections. Community-associated strains, while generally less virulent and susceptible to more antibiotics, can still cause significant morbidity and mortality.

Unlike flu, this isn't going to blow over in a month or two. It's going to keep getting gradually worse and worse. It is appropriate that we pay attention on the anniversary of the publication of On the Origin of Species (yup, that was November 24, 1859) because this is an example of Darwinian evolution. Believe.